You can watch a recording of Alan Milburn’s
controversial speech to the National Social Services Conference –
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download of realplayer basic
The full text is below:
19 October 2001
“I want to set out today some of the
improvements we have seen in the last year, some of the challenges
we now face and the further progress we can now make.
There is today a shared agenda between local government and
central government. A shared vision for social services and, I
hope, for the wider public services. That is a vision of services
designed around the needs of the user, rooted in the values of
In education: where pupils come first in highly performing local
schools at the heart of their communities.
In health: where patients come first in hospitals and GP
practices serving the needs of their communities.
And in social care: where the vulnerable adult or child come
first in safe and sound community services.
In all of these areas local government is a valued and valuable
partner. I strongly believe that should continue to be the
We have a shared agenda too, for improving quality in care. For
services that offer fair access to all and which help promote
opportunities for all.
I want to thank you for the contribution you make to the fairer
society we want to create. People who work in social care – and
those responsible for managing social care – do so under real
pressure. You are on the front line of many of the major challenges
which face our country today – addressing the problems of poverty
and deprivation, a growing elderly population, and growing public
And in this time of international tension, I want to place on
record my gratitude for the work of local government – officers and
members – in emergency planning and preparation. Your local
contribution is vital to our national vigilance.
Meeting these challenges must sometimes seem like a Herculean
task. Sometimes – often – there is scant thanks for what you do.
And yet just a few months ago when people faced the choice in this
country between short term tax cuts and long term investment in
public services, the public of this country backed public services
and they backed the people working in them. I think we should all
take heart from that.
Today people know a fair society, where everyone in our
communities and not just some get a fair chance, can only be built
on the sure foundations of a strong economy and strong public
There can be no such thing as a fair society – or a strong
economy – if the education system is geared to success for some but
not for all, or if whole communities are laid waste by the ravages
of drugs and crime. And we certainly cannot have a fair society if
health and social services deny people help when they need it,
where they need it.
We all know today we are a long way from having public services
to match Britain’s position as the fourth largest economy in
the world. We know too that the public are impatient for change.
Some people say public services can never deliver, that private
provision is the only answer for problems that are self
I say that on grounds of efficiency and equity that view is
wrong. But I say with equal firmness that failure to deliver reform
in public services will prove the doubters right.
Delivering improvements in public services – in all aspects of
our public services – is not an optional extra. In these next few
years progress must be made – and be seen to be made – in all of
our public services if we are to sustain progress towards the
fairer society we seek.
There are good grounds for optimism. For a start the investment
is going in. In health and education, with the NHS today the
fastest growing health care system of any major European
In social services investment is growing too. I know there is
real pressure on your budgets. I know that that’s true for
children’s care and as well as elderly care. And that is why
we responded just last week with a further £300 million of new
funding for social care. It brings growth in social care budgets up
to 3.7 per cent in real terms next year compared to growth of 0.1
per cent a year prior to this government coming to office. I know
we have not solved every funding problem. But we have made progress
– and we will go on making progress.
I want to give you an example of one area of progress. For
years, politicians and newspapers blamed social workers for just
about every ill our country faced. So, it is progress when I can
come to this conference and say without equivocation: we need more
social workers in this country not less.
That’s why today we are launching a three-year social work
recruitment campaign with a view to an extra 5,000 social workers.
I know that shortages of social care staff are biting hard in many
parts of the country. But these shortages can be turned round. The
nurse recruitment campaign we have run in the health service over
the last few years has proved that. Last year at your conference I
was able to provide extra cash to help students train for a career
in social work. Now the recruitment campaign will set out the
positive benefits of a social work career to help counteract the
all too frequent negative coverage the profession receives in the
Expanding staff numbers and investing in frontline services then
are the pre-conditions for improvements in social care. But
investment alone will not deliver. The courage to invest must be
matched with the courage to reform. And the courage to tell the
truth about how things really are.
While I see real beacons of excellence in social services – just
as there are real beacons of excellence elsewhere in public
services – the best has not been available to the many: it has all
too often only been available to the few. What is more, the needs
of the service user have all too often come a poor second to the
needs of the service provider.
In the modern world that will no longer do. To command public
confidence our public services today have to offer choice as well
as fairness to those who use them.
All the money in the world will not deliver these changes.
Indeed, there is a danger that simply pouring more money in without
linking it to reforms will ossify ways of working, embedding
attitudes and structures that are long overdue for change.
Reform in social services then is as vital as reform in any
other area of our public services. And just as in health or in
education there are four main principles which underpin the reform
First, high national standards and full accountability
Second, devolution to the front line to encourage diversity and
Third, flexibility around the needs of users in how staff are
employed and how services are organised
And fourth, the promotion of alternative providers and greater
So how should this programme apply to social services? Before I
answer that, let me just say this: I know change is difficult – I
know that there are real pressures out there – but it really must
happen. Whether it is the exceptional high profile service failure
or simply the day-to-day reality of unresponsive services, public
confidence cries out for change.
We should be confident that we can meet the challenge of change.
There is much to be proud of and much on which to build. The work
we have done together in bringing in the Quality Protects programme
with its focus on the needs of the most vulnerable children, the
General Social Care Council, the National Care Standards Commission
testifies to our shared commitment to improvements in social
So let me begin with standards and accountability.
People have the right to know that they will get certain minimum
standards wherever they live. And I am pleased to come to this
conference today and report real progress. Today I am publishing
the latest set of social services performance indicators. They
cover performance over the last three years.
Compared to last year, 20 out of 23 indicators show either
improvement or a continued high level performance.
More older people than ever before are being to helped to live
in their own homes rather than in care homes.
The number of children adopted has risen again giving them the
chance of a stable family life.
Compared to two years ago there are 850 more children who have
found permanent adoptive families – well on the way to
meeting our ambitions for a 40 per cent increase by 2005.
I really do want to congratulate you for the progress being
made. But as ever, there is much more to be done. It should concern
us all that the target on delayed discharges was missed. That means
people are being kept in hospital when they should be at home.
There was a slight improvement this year it is true, but with the
new money I announced last week for social services specifically to
address the “bed blocking” issue, I expect to see significant
improvements during the course of next year.
Similarly, more than six in 10 children are still going out into
the world from care without a formal qualification. None of us
would be happy with that for our own children. It is also
unacceptable that only one quarter of councils reviewed all their
child protection cases on time.
What is crystal clear from these tables is that there is
excellence in our social services. But it is excellence spread too
thinly. It is available only to some when surely our ambition as a
nation must be to make it available to all.
Of course local services should be attuned to the needs of
different local communities. That is why we have locally run social
services. But right now, as these tables show, the variation in
performance across social care is just too great.
Take London for example where there are particular problems with
cash pressures and wide societal pressures. In one part of the city
fewer than one in five children leaving care had a qualification.
In another part almost six in 10 had. In one part of the north only
2 per cent of looked-after children were adopted while in another
part five times that number were. In both examples, alongside
countless others, the councils concerned have similar locations,
deal with similar problems of poverty and deprivation and have
similar levels of funding.
These tables remove the excuses for unacceptable variations in
performance. This is not primarily about money. It is about
management and organisation. And that is the value of these tables.
They expose those areas where performance needs to improve. I know
there will always be arguments about the details in the tables and
the methodology behind them but for me – and I hope for you
too – there is a simple principle at stake here – the
public who use our public services have a right to know how well
those services are doing in comparison with others.
Public services don’t belong to me and they don’t
belong you to either. They belong to the public. Accessible
information for the users of public services is essential if we are
to design services around the needs of users. That is what we are
doing with schools and hospitals. And it is what we must now do for
I know that current tables are far from perfect and are far too
complicated. So I can announce today that we plan next year for a
new approach, which will provide more easily accessible information
to the public about social services performance. From next year, we
will bring together the existing performance data with information
from inspections and in-year monitoring. The result will be a more
rounded assessment of each council’s performance.
Just as we have recently done for hospitals this year, so from
next year each council will receive a star rating for its overall
social services performance. There will be separate ratings for
adult and children’s services. We will work with the LGA and
the ADSS on the details of the new system. I believe profoundly
that it will help councils to improve their performance.
That brings me to the second part of the reform programme
– devolving power and encouraging diversity.
Providing information to the public is just the first step.
Being able to act on it is what counts. Action should follow
assessment. Where there is good, bad and indifferent performance so
different approaches are clearly needed.
Where there is good performance we should step back. Where there
is poor performance we should be prepared to step in. We should
offer more rewards for the best performers. And more help to turn
around the poorer performers.
One of the greatest frustrations I hear expressed in the NHS and
in social care too is that all too often rather than rewarding the
good we simply bail out the bad. That is what we now must change if
we are to provide the right incentives for improvement in all
aspects of our social, and indeed all, services.
So beginning with this year’s best performers –
including the top 10 consistently high performing councils in
Derby, South Tyneside, Sunderland, Derbyshire, Cornwall, Rotherham,
York, Salford, Dudley and Leicestershire – in future all of
them will get the greater local freedom they have earned.
We will invite the best performers to discuss with us how they
could have greater control rather than less. We will explore with
them a lighter touch inspection regime with non-children’s
services being inspected, perhaps only every five years. We will
consider removing the conditions attached to special grants so that
top social services authorities are free to spend their money in
ways they decide can best make the improvements in services for the
communities they serve.
And we will give the best star rating performers their share of
next year’s new £50 million performance fund to spend as
they think fit. Some could go on staff bonuses. Some could go on
developing new services. The point is that it will purely be a
matter of local discretion.
The point is that good performance will earn the devolution of
power. This new approach will not only reward success among the
best it will encourage improvement among those who could be
The performance indicators show every council is doing well in
some areas. Some authorities while not yet the best are improving
and improving rapidly. Councils such as Cambridgeshire and
Newcastle-upon-Tyne deserve special praise since they have only
recently come out of special measures and they are making record
improvement. We now need to make sure that every one of them do
even better and that others can learn from what they have achieved.
We will look to the Social Care Institute for Excellence as it
develops its role, to disseminate and embed good practice.
I can announce today that we will consider using a part of the
new performance fund to allow the fastest improvers to spread the
benefits of their knowledge to others that are in most need of
For the few who are genuinely poor performers – including
the bottom 10 of the Isles of Scilly, Richmond on Thames,
Buckinghamshire, West Berkshire, Windsor & Maidenhead,
Kirklees, Torbay, Bracknell Forest, Warwickshire and Lambeth
– I believe that different action is needed. We already have
mechanisms to deal with poor performance including the powers to
put councils on special measures. There is evidence that
performance does improve when the SSI is closely involved. But
sometimes delivering improvements simply takes too long. So I can
say today that I will act using Best Value and other intervention
powers where the evidence suggests the pace of improvement is
simply too slow.
I will also be discussing with the LGA, and with Stephen Byers
at the DLTR, how we can use external expertise from the voluntary,
statutory and private sector to turn round performance where local
social services are persistently failing or falling behind.
We will want to explore in particular how to encourage the best
performing local social services to take over responsibility for
running the worst. I want to encourage in social care, as much as
we are trying to do in health care, the development of a new public
sector enterprise culture where we get the best people in public
services to lead improvements across the rest of our public
So, today I am putting this year’s worst performers on
First, they will be required to agree with the chief inspector
an action programme for improvement.
Second, special measures will follow if services do not
Third, by the time we award star ratings next summer, if
performance and prospects for further improvement remain poor, I
will consider using other intervention powers.
In some cases I know that social services management can
struggle because there are problems at the corporate or even the
political level. If I find evidence of corporate failures limiting
social services delivery I will consider triggering corporate
inspections so that we can find where the problems lie so then we
can tackle them.
Where councils and the NHS are not working together effectively,
I will consider asking the SSI and CHI jointly to investigate the
reasons for partnership problems. If necessary I will use my powers
to compel local health and social services to work more effectively
That brings me the third strand of the reform programme –
building services that are flexible enough to meet the needs of
their users. The painful truth about the way we organise care is
that it is like a maze for too many of its users.
There is confusion and uncertainty about where the
responsibilities of health and social care begin and end. Too often
people who rely on these services – whether they are elderly
or disabled or have a mental illness – find themselves faced
with an endless procession of staff carrying out roughly the same
assessments. And then of course there are turf wars over who funds
what and who does not.
I know there is a monumental effort going into all parts of the
country into improving partnership working both in health and in
social services. I want to thank you again for the progress you
have made. We saw the results of that last winter. I hope we can
see it again this winter. Where partnership works it works
brilliantly. Where it does not the needs of the user come a poor
second to disputes between services.
And let me just say candidly, I know the problem lies as much on
the NHS side of the fence as on your side. The answer is to take
down the fence. I believe we now have the means to do so.
From next year we will be putting in place a single process for
assessing the needs of elderly people for health and social care. I
hope that can be accompanied by fewer demarcations between staff to
build on the pioneering work in places like Wiltshire where social
workers and community nurses work as a single team.
Greater flexibility between staff needs to be matched by greater
flexibility between organisations. Frankly, so far I have been
disappointed by the take up of the legal powers, which are now
available, for health and social care to pool their budgets and
work more closely in partnership. I will be looking for faster take
up of these powers in the year ahead, towards our aim of having
them used in every part of the country.
What the bed-blocking problem in the NHS reveals is the simple
truth that social services and health services sink or swim
together. Each needs the other. The older person needs both. What
we have to move to then, is one care system. Not by takeovers but
Today, I am pleased to be able to confirm that next year the
first of up to 15 care trusts will come on stream, bringing
together in a single organisation health and social services for
older people or for people with mental health needs. Eventually, I
hope care trusts will be in place in all parts of the country
because they break through bureaucratic boundaries in order to
focus on the needs of service users.
That brings me to the final part of the reform programme –
promoting greater choice and diversity in provision. In social care
diversity of provision has already taken hold. Over 80 per cent of
residential care and over 50 per cent of home based care is
provided by the independent sector. Some of the best learning
disability services are run by voluntary organisations.
Yet for too long, in my view, there has been a stand off in the
relationship between the statutory, private and voluntary care
sectors. There should be no ideological barriers getting in the way
of the best care for vulnerable people.
Last week, I hope we saw the beginning of the end of that stand
off with the publication of the ground breaking agreement between
the government and representatives of the NHS, local councils and
independent sector providers in housing, health and social care.
The document we published, “Building capacity and partnership in
care”, marks a decisive break from the short termism of the past.
It sets out principles and practices to underpin what I hope will
become a more mature long term relationship between the public and
private care sectors.
The recent losses of capacity in the care home sector call for
such a relationship, with longer term contracts between councils
and care homes. They call for the independent sector to have a seat
at the table for planning future provision. They call for public
and private sectors to work together not just to shore up existing
provision in care homes but to develop new services in
people’s own homes: intensive home care packages; new more
active intermediate care where the emphasis is firmly on
rehabilitation and independence. All of this is about providing
more choice for users by promoting greater diversity in
The £300 million we announced last week to deal with the
problem of delayed discharge will translate the agreement into
action. This is a cash-for-change programme. We want to see real
change to eat into the bed blocking problem. By the end of this
winter, we want to see 1,000 fewer older people stuck in hospital
at any time, that way we can release 1,000 extra beds for other NHS
patients. Next year we will want to see further progress still
towards our aim of ending widespread bed blocking by 2004.
Together, people working in health and social services are at
can bring about these improvements. They can do it providing they
seize the opportunities which now exist to reform these
For too long, social services have been undervalued in our
country. Blamed when things go wrong. Ignored when things go right.
Often expected to fail. Sometimes set up to fail.
So, let us make a fair assessment of social services in our
Investment is now rising and performance is improving but there
is much more that must be done to put the needs of the user at the
centre of the service.
To do that, the best in social services must help reform the
rest of social services. The old barriers, which divided health
from social care, and separated public from private provision, must
now be overcome.
The poor performers must receive direct support to do
The big improvers must spread the lessons of improvement.
The best performers must have new freedoms to be better
None of this is easy. Much of it will take time. All of it
requires a huge amount of effort. This is a reform programme based
on our belief in public services and our belief in social services.
It is based also on our belief that these services can be better
– and must become better than they are today. And most of
all, we believe they can be better than they are. What we must now
do is demonstrate we can deliver. We’ve made substantial
steps forward – we need to build on that and we need to
deliver. The public expect no less.”